We are constantly told there is a doctor shortage in Nova Scotia. Yet statistically, we are about where we should be in terms of patient-doctor ratios. The problem with statistics is they get skewed by geography, since most of our doctors are concentrated in HRM.

Provincially, the hottest information in any community is not a scandal, but about a new doctor accepting patients.

On the surface, the province’s recently announced $200,000 contract with Emergency Medical Care to reduce ER closures by tapping a floating supply of provincial doctors seems a good idea. Anything that reduces closures and wait times is a good, right? In reality, this contract is a shining example of the failure of Nova Scotia health care as it is currently organized.

How is it that Nova Scotia’s 10 health authorities, using their existing army of over 400 administrators, can’t schedule staff?

And does the province actually understand the problem? Will this contract address all the issues?

On Sept. 19, a friend travelled to Halifax to meet with a surgeon about potential treatment. The surgeon was mad as hell over two surgeries that had to be cancelled that day because there were no operating room nurses. He was there, the patients were there, the nurses weren’t. Now nurses, like anyone else, get sick or have family emergencies arise. So how is it that in all of Halifax, which has 222 health-care administrators in the six-figure club, no one was capable of scheduling back-up OR support?

This isn’t a unique situation. I’ve spoken with a psoriasis sufferer who had treatments set back by four months because a support person was out sick. In June, Middleton Mayor Calvin Eddy complained that Annapolis Valley Health (AVH) scheduled ER closures at Soldiers’ Memorial Hospital on weekends when the town was hosting large events, like the ironically named Relay for Life which drew an additional 1,000 people to the community and again for the following weekend’s Antique Show and Shine. AVH said these closures were due to a doctor shortage.

Doctor shortages have been the quick and easy answer. But as we later learned, there appears to be a resistance by doctors to fill in at the Middleton ER because they’re paid $55 an hour less than their colleagues working in the Kentville ER, which are both under Annapolis Valley Health.

Additionally, the Annapolis Spectator reported that two ER closures in Middleton and Digby in the week between events were due to a nurse shortage.

In a Nov. 26, 2011, letter to The Chronicle Herald, Wayne Boucher, chairman of Friends of the Annapolis Community Health Centre, referenced a Nov. 19 announcement of a Collaborative Emergency Centre at the Annapolis Community Health Centre. Boucher said the 1,512 hours in ER closures in 2010-11 credited to doctor shortages was “emphatically not the case. Those hours had more to do with AVH decision-making than a doctor shortage. It is unclear why there were 104 hours of ER closure from July to October 2011. It was not due to a doctor shortage.”

There are enough examples coming out to suggest that ER closures and other treatment delays are more of a scheduling problem than a lack of available medical professionals. Otherwise, where is this private company finding a pool of available doctors? How come they can do it, but publicly paid administrators can’t? Is this some sort of subtle movement towards a private health system?

If we had better scheduling, maybe we wouldn’t lag behind the rest of the Canada in terms of treatment and delivery of services. Maybe the 58 per cent of Nova Scotians not getting knee-replacement surgery and 46 per cent not getting hip replacements within recommended treatment times would. Maybe children on eight-month-long pain-treatment waiting lists wouldn’t have to suffer so long.

We are always being told that productivity is a problem in Canada. The implication is that the “workers” have to do better. But what happens when the productivity failures are at the top?

Clearly, having our health care organized into 10 separate, competing, non-communicative silos is not productive, efficient, co-ordinated or in the best interest of patients. This contract illustrates the ongoing failure of our organizational structure. One provincial authority could ensure everyone working in health care was treated fairly and paid equally, and could better co-ordinate facilities, schedule doctors, nurses and support staff so that patients are treated in a more timely manner.

Nova Scotia is looking at all manner of ways to save money by reducing the numbers of council seats, re-aligning school boards, and discussing cutting the number of municipalities and merging driver’s licences and health cards. Yet health care, which consumes 40 per cent of the provincial budget, is allowed to flounder with an inefficient, non-responsive, top-heavy organizational structure. It’s clearly not working. Why stick with it?

Allan Lynch is a Valley-based writer, author, speaker and publisher of the blog: helphealthcare.ca.